3 Essential

(and 4 Frivolous)
Components of an
ADHD Diagnosis

From the ADHD Experts at

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 3 Essential
(and 4 Frivolous)
Components of an
ADHD Diagnosis
An accurate and well-rounded ADHD diagnosis comprises
several complex steps and evaluations. Here’s what that
process should look like — and expert opinions on today’s
diagnostic fads.

By Thomas E. Brown, Ph.D.

ADHD is a relatively common diagnosis, but that doesn’t mean it

should be ever pronounced lightly. An accurate and well-rounded
ADHD diagnosis is a complex, multi-step process, including a clinical
interview, a medical history review, and the completion of normed rat-
ing scales by loved ones, educators, and/or colleagues. Read on to bet-
ter understand the standard diagnostic steps — as well as some other
“tools” that just aren’t worth your time or money.
My “Aha” Moment
What a Diagnosis Should Comprise Readers share the
An in-depth, well-rounded ADHD evaluation comprises several moment they knew the
diagnosis was ADHD
components:
additu.de/aha
Clinical interview: The provider should first talk extensively
with the patient about his or her symptoms in an effort to pinpoint
their root causes. The underlying question here is: “Why do you think
you (or your child) may have ADHD?” — but in practice, this phase of
the evaluation is far more complex than that.
If the person says, “I have a hard time focusing,” for example, the
clinician needs to delve deeper — asking, “When? How do you notice
it? When is this difficulty most pronounced? Has this pattern existed
most of your life, or is it something that started occurring recently?” If
focus troubles are new, for instance, they could point to another condi- from the editors of

ADDITUDE
Strategies and Support for ADHD & LD
3
tion — depression or learning disabilities are both potential culprits.
The clinician’s job is to identify patterns that may point to ADHD, or
recognize that symptoms actually stem from something else.
The clinical interview helps the clinician understand the individu-
al’s biggest pain points — whether that’s at work, in school, or in per-
sonal relationships — and why they’re happening. It should cover:
- Challenges, symptoms

- Strengths, skills

- Family life, day-to-day stressors

- For children: school performance — grades, tests, homework, etc.

Free resource
- For adults: work performance — deadlines, productivity, etc. The ultimate guide to
ADHD medication
- General health — including sleep and eating habits additu.de/1a8

- Family medical history, including other possible instances of ADHD

- Drug use (both prescribed and illicit)

- Previous evaluations (if any) and their results

- Related and comorbid conditions — depression, anxiety, and learning
disabilities are common in people with ADHD
Very young kids may not participate in a clinical interview because
they often can’t fully articulate how they’re feeling or acting, but that
is the exception to the rule. Most children can answer a clinician’s
questions, and their parents should be interviewed as well — all the
way through college, if possible. Adult patients may invite a spouse or
close friend to paint a more complete picture of their symptoms and
struggles.
A good clinical interview may take 2 to 3 hours, which includes time
explaining to the patient what we now understand about ADHD and
what it means for them. Many clinicians don’t have the luxury of that
time — particularly pediatricians, who only have about 15 minutes for
each patient interview. In those cases, a patient may need to return 2 or 3 Essential
3 times in order to convey an adequate amount of information. (and 4 Frivolous)
Components of an
Normed rating scales: Practitioners next use rating scales ADHD Diagnosis
that have been used on a large number of subjects, some with ADHD from the editors of

ADDITUDE
Strategies and Support for ADHD & LD
4
and some without. These rating scales ask patients (or their parents)
to rate their symptoms in various situations, and help the clinician get
a sense of how a person’s symptoms compare to those of other people
their age. Respected rating scales include the Connors Scales, BASC,
the Brown ADD Scales, or the Barkley scales. Parents and teachers
should fill them out for children; adults can fill out their own scales.
Physical exam: Sometimes, ADHD-like symptoms are caused
by internal medical problems such as thyroid conditions or pinworms.
A pediatrician or primary care doctor should do a complete physi-
cal exam to make sure a medical problem has not been overlooked. A
physical exam can also assess whether an individual can safely take
ADHD medication.
All these puzzle pieces, taken together, help the clinician determine
whether an ADHD diagnosis is appropriate. If ADHD is diagnosed, the
clinician will follow up with the patient often — particularly if medica-
tion is prescribed — in order to assess the efficacy of treatment and to
determine if the initial evaluation missed anything.

What Doesn’t Help

You may have heard about one or more of the following diagnostic ADHD Assessments
Learn about six different
“fads,” which are generally not reliably accurate or comprehensive tests often used to
tools for an accurate diagnosis. diagnose ADHD
Brain imaging: Medical literature is ripe with news of interest- additu.de/tests
ing studies on brain scans — including MRIs, PETs, FMRIs, and DTIs
— and their provocative results. But people who really know about
brain imaging and ADHD will tell you that brain imaging is not a useful
diagnostic tool — yet. We are lacking the large number of normative
pictures needed to paint an accurate representation of what “normal”
looks like at different ages — making the tool’s diagnostic utility a thing
of the future, not the present.
Neuropsychological tests: Some patients get referred for
expensive — $2,000 to $4,000, usually — packages of neuropsycho-
logical tests as part of the ADHD diagnosis process. Unfortunately, I
can tell you these tests are generally useless for making an adequate
assessment of ADHD. The reason? These tests are usually given in an
office setting over a period ranging from 20 minutes to two hours. They
give the tester a snapshot of how that person’s brain might be function- 3 Essential
ing on that given day, but they don’t communicate a thing about how (and 4 Frivolous)
that person functions in day-to-day life. Neuropsychological tests are
Components of an
ADHD Diagnosis
a good way to evaluate brain damage after a traumatic brain injury or a
from the editors of

ADDITUDE
Strategies and Support for ADHD & LD
5
stroke, but they’re not particularly useful for being able to assess and
treat ADHD.
Online “reaction” tests: A wide variety of computerized “at-
tention tests” are available for a fee online. The tests’ creators claim
they can determine whether a user has ADHD based on his or her abil-
ity to hit a certain key every time a particular target comes on screen
— and refrain from hitting it when a different target is shown. In real-
ity, however, these tests are basically boredom tests — and they can be
easily manipulated by people who are naturally adept at video games
(which many with ADHD are). They very rarely produce false positives,
but they often return false negatives, and can miss ADHD in people
with quick reaction times or hand-eye coordination. Read more from Thomas
Genetic testing: Many researchers are studying the genetics of E. Brown, Ph.D.
ADHD, and some companies are jumping on the bandwagon by creat- additu.de/tbrown
ing “genetic tests.” In return for a mailed-in sample of saliva or blood,
patients receive a summary of their genetics — including possible
vulnerabilities to certain disorders. Unfortunately, these tests focus on
just a few genes, whereas a very large number of genes are implicated in
the genetic makeup of ADHD. And the fact is: you can’t say if a certain
person does or doesn’t have ADHD based on any genetic testing — it
simply does not work.

3 Essential
(and 4 Frivolous)
Components of an
ADHD Diagnosis
from the editors of

ADDITUDE
Strategies and Support for ADHD & LD
6
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